Methotrexate and newer RA treatments can also increase infection risk, so there’s often a tradeoff between treatment efficacy and infection risk, he said. Vaccination remains an important risk reduction strategy, and sometimes discontinuing or changing the immunosuppressive treatment proves necessary. The use of Janus kinase inhibitors, such as tofacitinib, adds another layer of complication for the rheumatologist; the reactivation of latent viruses in this scenario is a concern.
“The take-home message is that, yes, these drugs all increase the risk of infections at about the same rate, but they also reduce prednisone use,” Dr. Winthrop added.
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Larry Beresford is a freelance medical journalist in Oakland, Calif.
References
- Fleischmann R, Mysler E, Hall S, et al. Efficacy and safety of tofacitinib monotherapy, tofacitinib with methotrexate and adalimumab with methotrexate in patients with rheumatoid arthritis (ORAL Strategy): A phase 3b/4, double-blind, head-to-head, randomised controlled trial. Lancet. 2017 July 29;390(10093):457–468.
- Moreland LW, O’Dell JR, Paulus HE, et al. A randomized comparative effectiveness study of oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis: The treatment of early aggressive rheumatoid arthritis trial. Arthritis Rheum. 2012 Sep;64(9):2824–2835.
- Dale J, Stirling A, Zhang R, et al. Targeting ultrasound remission in early rheumatoid arthritis: The results of the TaSER study, a randomised clinical trial. Ann Rheum Dis. 2016 June;75(6):1043–1050.
- Haavardsholm EA, Aga AB, Olsen IC, et al. Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial. BMJ. 2016 Aug 16;354;i4205.
